ENT specialist
Otoscopy (looking inside the ear)
Otoscopy lets us look at your ear canal and eardrum with a light and a lens. It is the first ear examination: it takes seconds, does not hurt and needs no preparation.
What is otoscopy?
Otoscopy is the examination that lets us see inside your ear: the ear canal and the eardrum. We use an otoscope, a small hand-held instrument with a light and a magnifying lens that rests at the entrance of the ear canal. It is the first step in almost any ear appointment and only takes a few seconds.
In the ENT clinic we sometimes add a microscope (otomicroscopy) or a very thin camera called an endoscope (oto-endoscopy). These show the ear in more detail and leave both hands free to clean it if needed.
What is it for?
Looking in the ear answers a lot of questions quickly. We do it when you have:
- Earache or discharge: it helps tell a Middle ear infection from Swimmer’s ear.
- A blocked ear or hearing loss: this may be due to earwax, fluid behind the eardrum or Eustachian tube dysfunction.
- Itching, ringing (tinnitus) or dizziness.
- Check-ups: after an ear infection, with ear tubes (grommets) or with a known perforated eardrum.
We also do it before other ear tests, such as Pure-tone audiometry or Tympanometry, to check that the canal is clear.
How should I prepare?
You do not need any preparation.
- Do not clean your ears with cotton buds in the days before. They push wax further in and can irritate the canal.
- Tell us which drops you have used, and for how many days, if any.
- If you know you tend to get earwax build-up, softening it with drops for a few days beforehand can help. If we have not asked you to, there is no need.
- For young children, it helps to bring someone who can sit them on their lap.
What happens during the test?
- You sit down with your head turned slightly away from the ear we are looking at.
- We gently pull your ear to straighten the canal: up and back in adults, and back and slightly down in young children.
- We rest the otoscope at the entrance of the canal and look at the canal and eardrum. Only the tip goes in; it does not reach the eardrum.
- If wax or discharge blocks the view, we remove it there and then with fine suction or a small instrument, usually under the microscope.
- We repeat it in the other ear.
Looking in each ear takes a few seconds. If cleaning is needed, it may take a few minutes longer.
Young children sit on an adult’s lap, who holds their head gently against their chest. This keeps them still and makes the examination quicker and safer.
Does it hurt? Are there any risks?
It does not hurt. You will feel the otoscope at the entrance of your ear and, at most, slight pressure. If the canal is very inflamed, as in swimmer’s ear, touching the ear may be sore. We go gently and tell you before we start.
Looking in the ear carries no risk. Cleaning it can cause a loud noise from the suction, brief dizziness or, very rarely, a small graze on the skin of the canal that heals by itself.
Results
You get the result straight away: we tell you what we see there and then. Some common findings:
| What we see | What it usually means |
|---|---|
| Pearly grey, thin, shiny eardrum | Normal ear. |
| Red, bulging eardrum | Acute middle ear infection. |
| Fluid or bubbles behind the eardrum | Otitis media with effusion (“glue ear”), common in children. |
| Eardrum pulled inwards | Negative pressure in the middle ear, from a poorly working Eustachian tube. |
| Red, swollen canal with discharge | Outer ear infection (swimmer’s ear). |
| Wax filling the canal | Earwax blockage. |
| A hole in the eardrum | Perforated eardrum. |
We always assess what we see together with what you tell us and, if needed, a hearing test or tympanometry.
Frequently asked questions
Does otoscopy hurt? No. You will only feel the otoscope at the entrance of your ear. If the ear is very inflamed, it may be a little sore.
How long does it take? A few seconds per ear. A few minutes more if wax or discharge needs cleaning.
Can you remove earwax at the same appointment? Almost always, yes. If the wax is very hard, we may ask you to use drops for a few days and come back.
Is it the same examination my GP or paediatrician does? It is the same idea. In the ENT clinic we often also use the microscope or endoscope, which give a more detailed view and allow us to clean the ear.
My ear hurts but I am told it looks fine. How is that possible? Earache does not always start in the ear. It can come from the throat, the teeth or the jaw joint: TMJ disorder.
Can babies and children have it? Yes, at any age. For the youngest, an adult just needs to hold them still for a few seconds.
References
- Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
- Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99.
- Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014;150(1 Suppl):S1-S24.
- Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg. 2017;156(1_suppl):S1-S29.
For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.